New Data for Surgical Epilepsy Treatment

Early resective surgery should be considered in infants with epileptic encephalopathy (EE) due to malformation of cortical development for improvement of both seizure and developmental outcomes, according to research¹ presented at the 69^th Annual Meeting of the American Epilepsy Society (AES 2015).

The study, performed by Akio Takahashi, MD, of the National Center Hospital of Neurology and Psychiatry in Japan, and colleagues, was a retrospective analysis of 23 infants with EE who underwent epilepsy surgery between 2001 and 2012.

Most of the surgeries performed in this study were hemispherotomies but also included multi-lobar disconnection, lobar resection, lesionectomy, and callosotomy. Surgery outcomes were reported using the Engel Epilepsy Surgery Outcome Scale. Achieving a class I outcome indicates a seizure-free patient, and a class II outcome indicates rare disabling seizures.²

Of the 21 children who underwent resective surgery, 14 achieved Engel class I outcomes and 1 achieved a class II outcome. Further, all 15 children with class I or II outcomes showed improvement in psychomotor retardation.

Other research presented at AES 2015 also demonstrated the efficacy of surgery in treating epilepsy. According to one study,³ not only is epilepsy surgery a useful treatment option in patients with refractory epilepsy, but a repeat surgery is a good option if the first surgery fails.

Refractory epilepsy, or drug-resistant epilepsy, according to the International League Against Epilepsy, is a significant cause of morbidity and mortality in pediatric neurology, stated the authors of the study, Anuj Jayakar, MD, and Jeffrey Bolton, MD.

Though surgeries have good success rates, sometimes patients need subsequent surgeries to become seizure free. The goal of this study, a retrospective analysis, was to characterize the patients undergoing repeat surgery and assess outcomes.

Jayakar and Bolton examined data for 25 children, between the ages of 4 months and 22 years, with refractory epilepsy who underwent repeat epilepsy surgery at Boston Children’s Hospital between 2005 and 2014. The initial surgeries were 16 resections, 3 hemispherectomies, and 6 Visualase® ablations.

Of the patients receiving resections, 13 required further resection and 3 required hemispherectomies as their second surgeries. All 3 patients who had hemispherectomies required a second surgery to complete the hemispherectomy. Of the 6 Visualase® ablation patients, 5 needed resection around the ablation and 1 needed a second ablation procedure.

Cortical dysplasia (n=14) and post-surgical scarring (n=12) were the most common etiologies in this study. Others included tumor, gliosis, hippocampal sclerosis, and neuronal heterotopias. 

Following the second surgery, 15 patients had Engel class I outcomes, and another 4 had Engel class II outcomes. Further, 13 of the patients were able to wean off of at least 1 antiepileptic drug.

“Despite failure of the first attempt, a repeat surgery should be considered to produce good seizure control,” concluded Jayakar and Bolton.

The AES 2015 Annual Meeting was held December 4-8 in Philadelphia.

Poster Session 2. Dec. 6, 2015.

References:

1. Takahashi A, et al. Epilepsy surgery for epileptic encephalopathy in infancy. Poster presented at: 69^th Annual Meeting of the American Epilepsy Society; December 2015; Philadelphia, PA. Abstract 2.309.

2. Weiser HG, et al. ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epileptic surgery. Epilepsia. 2001;42(2):282-286.

3. Jayakar A, Bolton J. Clinical characteristics and outcomes in pediatric patients undergoing repeat epilepsy surgery. Poster presented at: 69^th Annual Meeting of the American Epilepsy Society; December 2015; Philadelphia, PA. Abstract 2.310.